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Front. Microbiol. | doi: 10.3389/fmicb.2017.01381

Non-antibiotic Isotretinoin treatment differentially controls Propionibacterium acnes on skin of acne patients.

  • 1School of Life Sciences, University of Lincoln, United Kingdom
  • 2School of Healthcare Science, Manchester Metropolitan University, United Kingdom
  • 3Dermatology Department, Lincoln County Hospital, United Kingdom

Emergence and potential transfer of antibiotic resistance in skin microorganisms is of current concern in medicine especially in dermatology contexts where long term treatment with antibiotics is common. Remarkably, non-antibiotic therapy in the form of isotretinoin - a non-antimicrobial retinoid is effective at reducing or eradicating the anaerobe Propionibacterium acnes which is causally involved in the complex pathogenesis of Acne vulgaris. This study measured the extent of colonisation of P. acnes in patients with primary cystic or severe acne from three defined skin sites in ‘non-lesion’ areas before, during and after treatment with isotretinoin. Patients attending acne clinics were investigated using standardized skin sampling techniques and the recovery of anaerobic P. acnes from 56 patients comprising 24 females and 32 males (mean age 22y, age range 15-46y) who were given a standard course of isotretinoin (1mg/kg/day) are reported. P. acnes cultured from the external cheek surface of patients following treatment showed a significant reduction (1-2 orders of magnitude) compared with their pre-treatment status. Interestingly, other distinct sites (nares and toe web) failed to show this reduction. In addition, high levels of antibiotic-resistant P. acnes were recorded in each patients’ skin microbiota before, during and after treatment. In this study, microbial composition of the skin appears substantially altered by isotretinoin treatment, which clearly has differential antimicrobial effects on each anatomically distinct site. Our study confirmed that orally administered isotretinoin shows good efficacy in the resolution of moderate to severe acne that correlates with reductions in the number of P. acnes on the skin, including resistant isolates potentially acquired from previous treatments with antibiotics. Our study suggests that the role of tetracycline’s and macrolides, which are currently first line treatments in dermatology, might be reserved for severe or life-threatening infections since current antibiotic stewardship guidelines from medical departments no longer prescribe these antibiotics for routine use.

Keywords: Acne Vulgaris, Skin microbiome, antibiotic resistance, isotretinoin drug treatment., microbial population ecology

Received: 09 Nov 2016; Accepted: 07 Jul 2017.

Edited by:

Yuji Morita, Aichi Gakuin University, Japan

Reviewed by:

Annika Flint, Health Canada, Canada
Yoshimune Nonomura, Yamagata University, Japan
Rolf Lood, Lund University, Sweden
Cassandra L. Quave, Emory University School of Medicine, United States  

Copyright: © 2017 Ryan-Kewley, Wiilliams, Hepburn and Dixon. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Ronald A. Dixon, University of Lincoln, School of Life Sciences, Green Lane, Lincoln, LN6 7DL, Lincolnshire, United Kingdom, rdixon@lincoln.ac.uk